[STUDY] Environmental Infection Prevention and Control

Pathogens are found in

• Air

• Water

• Fomites (objects/ surfaces)

= cause healthcare associated infections (HAIs)

How CDC conclude its from environment

• Organism survives in those 3

• Grows there, infection cant be explained any other way

• Removing contamination stops disease transmission

Whos at greatest risk?

• Immunocompromised individuals

< 500 cells of absolute neutrophils

4 airborne hazards

1. Droplets

2. Droplet nuclei

3. Laser plume/ Surgical smoke

4. Aerosolized allergens

Droplets

• >5 µm

• Cough/ sneeze

• Settle quickly

• Travel within 3 ft

Droplet nuclei

• 1–5 µm

• Suspended in air

• Travel beyond 3 ft

• Remain airborne indefinitely in cool, dry air

• Spread by inhalation, contact with contaminated stuff

• TB/ measles

Laser plume/ Surgical smoke

• Produced by lasers, electrosurgical units

• Contains gas, tissue debris, aerosolized agents

• Spread HIV, HPV

Aerosolized allergens

Protein particles suspended in air

• Latex gloves

• Carpeting

• Cloth furnishings

Air quality infection prevention

• Maintains temp, humidity, odors

• Removes contaminated air, airborne pathogens, allergens

• Must monitor regularly, remove excess moisture

Poor HVAC system = spread these

how to maintain acceptable indoor air quality

• Monitor HVAC

• Laser surgical smoke

  • Wear N95 or N100

• Latex

  • Low protein or laxtex free gloves

Special ventilation areas

1. Operating rooms

2. Protective environment (PE) rooms

3. Airbone infection isolation rooms (AIIR)

Water

• Microorganisms grow in warm temp/ nutrient source

  • Reservoir

• Transmit through — direct contact, drinking water, aerosols

• Safe drinking water = Less than 500 CFU/mL

Universal point of use fixtures

• water in healthcare facilities

  • Sinks

  • Faucets

  • Toilets

  • Eye wash stations

= Clean regularly, EPA disinfectant, flush eyewash stations weekly with sterile water

Special point of use fixtures

• High speed handpieces

• Sonic/ ultrasonic scalers

• Air—water syringes

  • Flush 20—30 secs after every patient

  • Does NOT use public water

= Biofilm can develop (legionella, pseudonomas, nontuberculous mycobacteria)

Fomites

• Environmental surfaces

• Lowest risk of transmission

• Indirect contact

Factors affecting microorganisms on surfaces

• Number of people

• Activitty

• Moisure

• Nutrient avail

• Surface orientation

2 categories of fomites

Clinical contact

• X ray machines

• Dental units

• Equipment controls

Housekeeping surfaces

• Frequent

  • Doorknobs

  • Light switches

• Minimal contact

  • Floors, walls, blinds, curtains

= No evidence of transmissions from housekeeping surfaces

Cleaning vs disinfecting

Cleaning

• FIRST

• Removes organic matter

• scrubbing, detergents, water

Disinfection

• High level

  • Glutaraldehyde

  • Peracetic acid

  • Hydrogen peroxide

• Intermediate level

  • Sodium hypochlorite

  • alcohol

  • Phenollcs

  • Iodophors

= Not sporicidal

• Low level

  • Quaternary ammonium compound

Only disinfect for heat sensitive instruments — not environmental surfaces

List N disinfectant

Contains

• Intermediate and low level disinfectants

• Effect against covid

Carpet and cloth furnishings

• Harbor microorganisms, aerosolized allergens

• Vacuum regularly, avoid areas where spills are likely

Flowers or plants

• Staff only — no patient contact

• Wear gloves

• Wash hands after

• Change vase water -— every 2 days

• Clean/ disinfect vase

• No potted plants or fresh flowers near immunocompromised patients

Pest control

• Eliminate food

• Eliminate habitat

• Pesticides

Contaminated laundry

• Wear PPE

• Leak proof bags

• Wash at ≥160°F (71°C) for ≥25 minutes if using hot water

Service animals

• Allowed under ADA

• Remove if threat

  • Must arrange care

  • Address patient’s needs

Waste management

Most waste in healthcare

• Office waste/ Municipal

• Hazardous

• Universal

• Medical

  • Regulated medical — enforced by OSHA

  • Infectious or noninfectious